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Randomised controlled\/clinical trials in adults with low back pain of interventions to optimise surgery rates or referrals to surgery or secondary referral were included. Bias was assessed using the Cochrane ROB2 tool and evidence certainty via Grading of Recommendations Assessment, Development and Evaluation (GRADE). A random effects meta-analysis with a Paule Mandel estimator plus Hartung\u2013Knapp\u2013Sidik\u2013Jonkman method was used to calculate the odds ratio and 95% confidence interval, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 886 records, 6 studies were included (<jats:italic>N<\/jats:italic>\u2009=\u2009258,329) participants; cluster sizes ranged from 4 to 54. Five studies were rated as low risk of bias and one as having some concerns. Two studies reporting spine surgery referral or rates could only be pooled via combination of <jats:italic>p <\/jats:italic>values and gave evidence for a reduction (<jats:italic>p<\/jats:italic>\u2009=\u20090.021, Fisher\u2019s method, risk of bias: low). This did not persist with sensitivity analysis (<jats:italic>p<\/jats:italic>\u2009=\u20090.053). For secondary referral, meta-analysis revealed a non-significant odds ratio of 1.07 (95% CI [0.55, 2.06], <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200973.0%, <jats:italic>n<\/jats:italic>\u2009=\u20094 studies, Grading of Recommendations Assessment, Development and Evaluation [GRADE] evidence certainty: very low).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Few RCTs exist for interventions to improve guideline-adherent spine surgery rates or referral. Clinician education in isolation may\u00a0not be effective. Future RCTs should consider organisational and\/or policy level interventions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>PROSPERO registration<\/jats:title>\n                <jats:p>CRD42020215137.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00586-022-07378-6","type":"journal-article","created":{"date-parts":[[2022,9,17]],"date-time":"2022-09-17T10:02:36Z","timestamp":1663408956000},"page":"2851-2865","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Interventions for promoting evidence-based guideline-consistent surgery in low back pain: a systematic review and meta-analysis of randomised controlled trials"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9307-832X","authenticated-orcid":false,"given":"Daniel L.","family":"Belavy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Scott D.","family":"Tagliaferri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Buntine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Saueressig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katja","family":"Ehrenbrusthoff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaolong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashish","family":"Diwan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clint T.","family":"Miller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Owen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,9,17]]},"reference":[{"key":"7378_CR1","doi-asserted-by":"publisher","first-page":"2356","DOI":"10.1016\/S0140-6736(18)30480-X","volume":"391","author":"J Hartvigsen","year":"2018","unstructured":"Hartvigsen J, Hancock MJ, Kongsted A et al (2018) What low back pain is and why we need to pay attention. 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